Provider Demographics
NPI:1235170788
Name:NOWOTNY, WILLIAM K (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:K
Last Name:NOWOTNY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 COLUMBIANA RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16102-2904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6505 MARKET ST
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-3457
Practice Address - Country:US
Practice Address - Phone:330-726-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007390207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00194541OtherMEDICARE TRAVELERS RR-GA
OH2190203Medicaid
OH942460636120OtherCARESOURCE
OHNO4030884Medicare ID - Type Unspecified
OH942460636120OtherCARESOURCE